Establishment and diagnostic value of an early warning model for acute pancreatitis complicated with acute respiratory distress syndrome
10.3760/cma.j.issn.1671-0282.2023.08.007
- VernacularTitle:急性胰腺炎并发急性呼吸窘迫综合征早期预警模型的建立及诊断价值分析
- Author:
Cheng CHI
1
;
Ying ZHOU
;
Xiaojing SONG
;
Yong MA
;
Jihong ZHU
Author Information
1. 北京大学人民医院急诊科，北京 100044
- Keywords:
Acute pancreatitis;
Acute respiratory distress syndrome;
Warning model;
Diagnostic value
- From:
Chinese Journal of Emergency Medicine
2023;32(8):1046-1052
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To establish an early warning model for acute pancreatitis (AP) complicated with acute respiratory distress syndrome (ARDS) and to evaluate its diagnostic value.Methods:Acute pancreatitis patients treated in the Emergency Department of Peking University People's Hospital from January 2018 to January 2021 were selected as the research subjects. At 14 days after the diagnosis of acute pancreatitis, the patients were divided into the ARDS group and the control group according to whether ARDS occurred. The general characteristics, laboratory examination results, imaging features, and clinical scores of the two groups of patients were compared. One-way analysis was performed first, and the indicators with statistical and clinical significance were then analyzed by multivariate logistic analysis. Finally, a risk prediction model was established, and the diagnostic sensitivity and specificity of the predictive model were calculated. The receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated. The diagnostic value of the model was compared with the Ranson score and BISAP score.Results:A total of 442 patients were selected for this study, including 72 patients in the ARDS group and 370 patients in the control group. Compared to the control group, the ARDS group had a higher proportion of early fever and a lower oxygenation index. Inflammatory indicators γ- GGT, blood amylase, blood urea nitrogen, and blood glucose levels in the ARDS group were significantly higher than those in the control group, while blood calcium, plasma albumin, and carbon dioxide binding capacity levels were significantly lower than those in the control group. Univariate and multivariate logistic regression analysis was conducted on the statistically significant and clinically significant indicators mentioned above. The increased neutrophil count ( OR=2.838, 95% CI: 1.339-6.018, P=0.007), increased procalcitonin level ( OR=1.198, 95% CI: 1.025-1.399, P=0.023), increased blood urea nitrogen level ( OR=1.665, 95% CI: 1.463-1.955, P=0.027) and the decreased oxygenation index ( OR=0.603, 95% CI: 0.384-0.949, P=0.029) were associated with acute pancreatitis complicated with ARDS. According to the above factors, an early warning model for acute pancreatitis patients complicated with ARDS was established: logistic ARDS/A P=35.131+1.043NEUT+0.408BUN-0.505OI+0.18PCT. The diagnostic sensitivity of this early warning model was 84.72% (61/72), the specificity was 85.68% (317/370), the positive predictive value was 53.51% (61/114), the negative predictive value was 96.64% (317/328), the diagnostic accuracy was 85.52% (378/442), and the area under the ROC curve was 0.894 (95% CI: 0.851-0.938). The predictive ability of this early warning model in acute pancreatitis complicated with ARDS was superior to the Ranson score, BISAP score, APACHE Ⅱ score and CTSI score (AUC: 0.894 vs. 0.823 vs.0.756 vs. 0.818 vs.0.723). Conclusions:The prediction model based on neutrophil count, blood urea nitrogen, early oxygenation index and procalcitonin has the value of early prediction of acute pancreatitis complicated with ARDS, and is superior to other scoring systems, which can better guide treatment and improve prognosis.
